Burnout Review

Job-related Burnout: A Review

This review focuses on the conceptual meaning of burnout and on some of the major
antecedents, symptoms, and consequences of burnout in work organizations. Burnout is viewed
as an affective reaction to ongoing stress whose core content is the gradual depletion over time of
individuals intrinsic energetic resources, including the expression of emotional exhaustion,
physical fatigue, and cognitive weariness (Shirom, 1989). The review starts with a critical
analysis of the major conceptual approaches to burnout. Given the complexity of this construct
and the controversy over its operational definition (Maslach, Schaufeli, & Leiter, 2001), this
conceptual analysis is essential for understanding the phenomenon of burnout. Since in this field
of research there are few attempts to theoretically posit burnouts relationships with other
variables (Moore, 2000), I proceed in the next section to theoretically inter-relate stress at work
and burnout. The following sections cover the empirical literature on burnout. Typically,
empirical studies on burnout are based on a cross-sectional study design and measure burnout by
asking respondents to complete a self-report questionnaire. In this review, preference is given to
longitudinal studies on burnout since they provide more credence to cause and effect statements.
To summarize the empirical evidence available on burnout, I shall rely on the few meta-analytic
studies of burnout and on the narrative, mostly occupation-specific, literature reviews. The
sections that follow deal with personality traits associated with burnout, burnout and job
performance, burnout and health, burnout at the organizational level of analysis, and approaches
to reduce burnout in work organizations.
This review focuses on burnout of employees in work organizations, excluding research
that deals exclusively with non-employment settings (e.g., athletes burnout: Dale & Weinberg,
1990). In the same vein, I shall not cover research that deals with burnout in life domains other

Burnout Review

than work, like crossover of burnout among marital partners (e.g., Pines, 1996; Westman &
Etzion, 1995). This review gives preference to research that investigated work-related
antecedents of burnout rather than to studies in which burnout has been associated with stresses
in other life spheres (e.g., Farber, 1991, 2000; Jackson, Schwab & Schuler, 1986). In several
advanced market economies, like the USA, Netherlands and the UK, the incidence of stressrelated workers compensation claims, and the frequency of mental health claims for every 1000
employees covered by the relevant workers compensation laws, have risen sharply in recent
years (cf. Schaufeli & Enzmann, 1998). Therefore, burnout at work can be regarded as a major
public health problem and a cause for concern for policy makers.
The Conceptual Basis of Burnout
During the 1980s and early 1990s, research on burnout, regardless of the conceptual
approach employed, dealt almost exclusively with people-oriented professionals (e.g., teachers,
nurses, doctors, social workers, and policepersons). Professional in these occupational groups
tend to be employed in the public sector. In most of todays advanced market economies, the
public sector has to adjust to consumers growing demands for quality service, downsizing, and
budgetary retrenchments. People-oriented professionals often enter their profession with serviceoriented idealistic goals. They typically work under norms that expect them to continuously
invest emotional, cognitive and even physical energy in service recipients. In this context, the
above changes were likely to create a process of emotional exhaustion, mental weariness and
physical fatigue. One of the early pioneers in scientifically investigating this phenomenon,
Freudenberger (Freudenberger, 1974, 1980) labeled it as burnout.
Freudenberger pioneering work inspired the three conceptual approaches toward the
construct of burnout reviewed here. These three conceptualizations were proposed by Maslach

Burnout Review

and her colleagues (Maslach, 1982; Maslach & Leiter, 1997), by Pines and her colleagues (Pines
& Aronson, 1988; Pines, Aronson & Kafry, 1981) and by Shirom and Melamed (Shirom, 1989;
Hobfoll & Shirom, 1993, 2000; Melamed, Kushnir & Shirom, 1992). I shall focus on the validity
of the first conceptual approach toward burnout, including the measurement instrument
constructed by Maslach and her colleagues, the Maslach Burnout Inventory [MBI] (Maslach,
Jackson, & Leiter, 1996). The reason for this focus is that the MBI was one of the very first
scientifically validated burnout measurement instruments, and it has been the most widely used in
scholarly research (Schaufeli & Enzmann, 1998). The first version of the MBI reflected the
fields preoccupation with professionals in people-oriented occupations. Subsequently, the
construction of newer versions of the popular MBI, applicable to other occupational groups
(Maslach, Jackson & Leiter, 1996) extended the study of burnout to other categories of
employees.
The Maslach Burnout Model and Inventory
According to this conceptualization (Maslach & Jackson, 1981; Maslach, 1982; Maslach
& Leiter, 1997), burnout is viewed as a syndrome that consists of three dimensions: emotional
exhaustion, depersonalization, and reduced personal accomplishment. Emotional exhaustion
refers to feelings of being depleted of ones emotional resources. This dimension was regarded as
the basic individual stress component of the syndrome (Maslach, Schaufeli, & Leiter, 2001).
Depersonalization, referring to negative, cynical or excessively detached response to other people
at work, represents the interpersonal component of burnout. Reduced personal accomplishment,
referring to feelings of decline in ones competence and productivity and to ones lowered sense
of self-efficacy, represents the self-evaluation component of burnout (Maslach, 1998, p. 69). The
three dimensions were not deducted theoretically but resulted from labeling exploratory factor-

Burnout Review

analyzed items initially collected to reflect the range of experiences associated with the
phenomenon of burnout (Maslach, 1998, p. 68; Schaufeli & Enzmann, 1998, p. 51).
Subsequently, Maslach and her colleagues modified the original definition of the latter
two dimensions (cf. Maslach, Schaufeli, & Leiter, 2001, p. 399). Depersonalization was replaced
by cynicism, referring to the same cluster of symptoms. The new label for this dimension of the
syndrome poses new problems. Cynicism is an emerging concept in psychology and
organizational behavior, used to refer to negative attitudes involving frustration from,
disillusionment and distrust of organizations, persons, groups or objects (Andersson & Bateman,
1997; Dean, Brandes, & Dharwadkar, 1998). Abraham (2000) has suggested that work cynicism,
one of the forms of cynicism that she had identified in her research, tends to be closely related to
burnout. Garden (1987) has argued that this dimension of the syndrome of burnout gauges several
distinct attitudes, including distancing, hostility, rejection, and unconcern. It follows that the
discriminant validity of this component of burnout relative to the current conceptualizations of
employee or work cynicism has yet to be established.
The third dimension was re-labeled as reduced efficacy or ineffectiveness, depicted to
include the self-assessments of low self-efficacy, lack of accomplishment, lack of productivity,
and incompetence (Leiter & Maslach, 2001). Each of these concepts, namely self-efficacy,
accomplishment or achievement, personal productivity or performance, and personal competence,
represent well-known distinct fields of research in the behavioral sciences. The authors of the
MBI have yet to clarify on what theoretical grounds these concepts should be grouped together in
the same cluster of symptoms. Such diverse cluster of symptoms related to effectiveness may
obscure the meaning of the third dimension underlying the MBI. To illustrate, does reduced
efficacy refer to ones personal judgment of how well one can execute courses of action required

Burnout Review

to deal with prospective situations, as self-efficacy is customarily defined (e.g., Lee & Bobko,
1994; Stajkovic & Luthans, 1998)? Alternatively, does this dimension of burnout reflect ones
belief in ones knowledge and skills, as competence is often conceptualized (Foschi, 2000;
Sandberg, 2000)? Or does it relate to self-assessed job performance or performance expectations
(e.g., Stajkovic & Luthans, 1998)? It appears that the second and third dimensions of the MBI, as
currently defined, probably represent each several multifaceted constructs, each having different
implications with regard to the emotional exhaustion component of burnout suggested by the
authors of the MBI (cf. Moore, 2000, p.341).
Clearly, the conceptualization of burnout as tapped by the MBI relates to it as a
multidimensional construct. A construct is multidimensional when it refers to several distinct but
related dimensions that are viewed as a single theoretical construct (Law, Wang, & Mobley,
1998). The proponents of this multidimensional view of burnout (e.g., Maslach, 1998) argue that
it provides a holistic representation of a complex phenomenon, broadly conceived as referring to
the process of wear and tear or continuous encroachment upon employees resources. However,
they have yet to provide convincing theoretical arguments as to why the three different clusters of
symptoms that comprise their conceptualization of burnout should hang together (Maslach,
Schaufeli, & Leiter, 2001). They further argue that their conceptualization allows researchers to
use broadly conceived types of stress in both the work and the family domains as potential
antecedents of burnout, thus increasing its explained variance. However, there is a paucity of
evidence that there are specific antecedent variables or mechanisms leading to all three clusters of
symptoms included in the syndrome of burnout (Collins, 1999; Lee & Ashforth, 1996; Schaufeli
& Enzmann, 1998). A case in point is the phase model of burnout, developed by Golembiewski
and his colleagues and tested in a series of studies (see, for example, Golembiewski & Boss,

Burnout Review

1992; Golembiewski, Munzenrider, & Stevenson, 1986; Golembiewski & Munzenrider, 1988). It
was constructed on the basis of the theoretical assumption that individuals experiencing burnout
on the dimension of emotional exhaustion do not necessarily experience either of the other two
clusters of symptoms. Indeed, Golembiewski and his colleagues (cf. Golembiewski et al.,
1986,1988, 1992) have provided in their books considerable amount of evidence that supports
this theoretical proposition.
Maslach (1998, p. 70) has argued that the addition of the dimensions of cynicism and
reduced personal efficacy to the core dimension of emotional exhaustion was justified in that the
former two dimensions add the interpersonal aspect of burnout to the conceptualization of the
phenomenon. However, items that tap interpersonal aspects of work appear in the emotional
exhaustion scale, like working with people all day is really a strain for me, and Working with
people directly puts too much stress on me (Maslach & Jackson, 1981). Conceptually, therefore,
the view of burnout as a syndrome that includes three clusters of symptoms lacks theoretical
underpinnings, has not been supported by evidence demonstrating common etiology for the three
dimensions, and includes two clusters of symptoms, cynicism an reduced personal effectiveness,
that appear to be too heterogeneous for advancing our knowledge on burnout.
The MBI, the measurement scale whose process of construction has led inductively to the
above conceptualization, has been the most popular instrument for measuring burnout in
empirical research (for a review of studies using it, see Collins, 1999; Lee & Ashforth, 1996;
Schaufeli & Enzmann, 1998). It contained items purportedly assessing each of the three clusters
of symptoms included in the syndrome view of burnout, that is emotional exhaustion, cynicism or
depersonalization, and reduced effectiveness or lowered professional efficacy. It asks respondents
to indicate the frequency over the work year with which they have experienced each feeling on a

Burnout Review

7-point scale ranging from 0 (never) to 6 (every day). Three subscales are usually constructed,
referring to each of the above dimensions (for a recent psychometric critique, see Barnett,
Brennan, & Careis, 1999). The factorial validity of the MBI has been extensively studied (Byrne,
1994; Handy, 1988; Lee & Ashforth, 1996; Schaufeli & Dierendonck, 1993; Schaufeli & Buunk,
1996). Most of the researchers examining this aspect of MBI validity have reported that a threefactor solution better fits their data than does a two-dimensional or a one-dimensional structure
(for recent examples, see Boles, Dean, Ricks, Short & Wang, 2000; Schutte, Toppinen, Kalimo,
& Schaufeli, 2000). Researchers using the MBI have most often constructed three different scales
corresponding to the three dimensions of emotional exhaustion, cynicism, and reduced personal
effectiveness. Several studies have argued, on both theoretical and psychometric grounds, that the
use of a total score to represent total burnout should be avoided (e.g., Moore, 2000; Kalliath,
ODriscoll, Gillepsie & Bluedorn, 2000; Koeske & Koeske, 1989). The emotional exhaustion
dimension has been consistently viewed as the core component of the MBI (e.g., Moore, 2000;
Cordes, Dougherty & Blum, 1997; Burke & Greenglass, 1995). Most studies have shown it to be
the most internally consistent and stable relative to the other two components (Schaufeli &
Enzmann, 1998). In meta-analytic reviews, it has been shown to be the most responsive to the
nature and intensity of work-related stress (Lee & Ashforth, 1993; Schaufeli & Enzmann, 1998).
Pines Burnout Model and Measure
Pines and her colleagues defined burnout as the state of physical, emotional and mental
exhaustion caused by long term involvement in emotionally demanding situations (Pines &
Aronson, 1988, p. 9). This view does not restrict the application of the term burnout to the
helping professions, as was initially the case with the first version of the MBI (Winnubst, 1993).
A possible drawback is that this approach does not view burnout in a work context. Indeed, it was

Burnout Review

applied not only to employment relationships (Pines, Aronson & Kafry, 1981) and organizational
careers (Pines & Aronson, 1988), but also to marital relationships (Pines, 1988, 1996) and to the
aftermath of political conflicts (Pines, 1993).
Much like the MBI, the conceptualization of burnout emerged from clinical experiences
and case studies. In the process of actually constructing a measure that purported to assess
burnout, dubbed the BM, Pines and her colleagues have moved away from the definition offered
above. In the BM, Pines and her colleagues view burnout as a syndrome of co-occurring
symptoms that include helplessness, hopelessness, entrapment, decreased enthusiasm, irritability,
and a sense of lowered self-esteem (cf. Pines, 1993). None of these symptoms is anchored in the
context of work or employment relationships. The BM is considered a one-dimensional measure
yielding a single composite burnout score. Evidently, the overlap between the conceptual
definition and the operational definition is minimal (cf. Schaufeli & Enzmann, p. 48). In addition,
the discriminant validity of burnout, as assessed by the BM, relative to depression, anxiety, and
self-esteem, is impaired (cf. Shirom & Ezrachi, 2001). This has led researchers to describe the
BM as an index of psychological strain that encompasses physical fatigue, emotional exhaustion,
depression, anxiety, and reduced self-esteem (e.g., Schaufeli & Dierendonck, 1993, p. 645).
Shirom-Melamed Burnout Model and Measure (S-MBM)
The conceptualization of burnout that underlies the Shirom-Melamed Burnout Measure
(S-MBM) was inspired by the work of Maslach and her colleagues and Pines and her colleagues,
as described above. Burnout is viewed as an affective state characterized by ones feelings of
being depleted of ones physical, emotional, and cognitive energies. Theoretically, the S-MBM
was based on Hobfolls (1989, 1998) Conservation of Resources [COR] theory. COR theorys
basic tenets are that people have a basic motivation to obtain, retain, and protect that which they

Burnout Review

value. The things that people value are called resources, of which there are several types,
including material, social, and energetic resources. The conceptualization of burnout formulated
by Shirom (1989) on the basis of COR theory (Hobfoll & Shirom, 1993, 2000) relates to
energetic resources only, and covers physical, emotional, and cognitive energies. Burnout thus
represents a combination of physical fatigue, emotional exhaustion, and cognitive weariness.
According to COR theory (Hobfoll, 1989, 1998) stress at work occurs when individuals
are either threatened with resource loss, lose resources, or fail to regain resources following
resource investment. One of the corollaries of COR theory is that stress does not occur as a single
event, but rather represents an unfolding process, wherein those who lack a strong resource pool
are more likely to experience cycles of resource loss. The affective state of burnout is likely to
exist when individuals experience a cycle of resource loss over a period of time at work (Hobfoll
& Freedy, 1993). For example, a reference librarian who comes to work every morning to face
yet another line of students impatiently awaiting her help, lacking opportunities to replenish her
resources, is likely to cycle into a forceful spiral of resource loss and as a result feel burned out at
work.
There are three reasons for the focus on the combination of physical fatigue, emotional
exhaustion and cognitive weariness in the conceptualization of burnout that has led to the
construction of the S-MBM. First, these forms of energy are individually possessed, and
theoretically are expected to be closely interrelated. COR theory postulates that personal
resources affect each other and exist as a resource pool, and that lacking one is often associated
with lacking the other (Hobfoll & Shirom, 2000). Empirical research conducted with the S-MBM
has supported the linkage among physical fatigue, emotional exhaustion and cognitive weariness
(e.g., Melamed, Kushnir & Shirom, 1992; Shirom, Westman, Shamai, & Carel, 1997). Second,

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the three forms of individually possessed energy included in the S-MBM represent a coherent set
that does not overlap any other established behavioral science concept, like depression and
anxiety or like aspects of the self-concept such as self-esteem and self-efficacy. Third, the
conceptualization of the S-MBM clearly differentiates burnout from stress appraisals anteceding
burnout, from coping behaviors that individuals may engage in to ameliorate the negative aspects
of burnout like distancing themselves from client recipients, and from probable consequences of
burnout like performance decrements. This stands in contrast to the two other conceptualizations
of burnout outlined above.
A series of studies that confirmed expected relationships between the S-MBM and
physiological variables have lent support to its construct validity. In these studies, respondents
total score on the S-MBM was used to predict risk factors for cardiovascular disease (Melamed,
Kushnir & Shirom, 1992; Shirom, Westman, Shamai, & Carel, 1997), quasi-inflammatory factors
in the blood (Lerman, Melamed, Sharagin, Kushnir et al., 1999), salivary cortisol levels
(Melamed, Ugarten, Shirom, Kahana et al., 1999) and upper respiratory infections (Kushnir &
Melamed, 1992). However, the convergent validity of the S-MBM relative to the MBI and the
BM has yet to be established, as has its discriminant validity relative to other types of possible
emotional reactions to chronic stress at work, like anger, hostility, anxiety, and depressive
symtomatology. The factorial validity of the S-MBM needs to be investigated in additional
occupational categories. Also, there is a paucity of evidence with regard to the possibility that
different types of stress may have varying effects on physical fatigue, emotional exhaustion, and
cognitive weariness, thus casting doubt on the use of a single composite score of the S-MBM to
represent burnout. There is some indirect evidence suggesting that each of the three components
of the S-MBM may be related to a different coping style (Vingerhoets, 1985).

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Models of Stress at Work and Burnout

Past reviews of the burnout literature (i.e., Burke & Richardson, 2000; Cordes &
Dougherty, 1993; Moore, 2000; Schaufeli & Peeters, 2000; Hobfoll & Shirom, 2000; Shirom,
1989) view it as a consequence of ones exposure to chronic job stress. The chronic stresses that
may lead to burnout include qualitative and quantitative overload, role conflict and ambiguity,
lack of participation, and lack of social support. Burnout has been shown to be more job-related
and situation-specific relative to emotional distress such as depression (Maslach, Schaufeli, &
Leiter, 2001). Among the major theoretical approaches to work-related stress and its outcomes
reviewed in Cooper (1998), those that have been applied to investigate stress burnout relations
are the demand-control-support model, the effort-reward imbalance perspective, and the personenvironment fit model. It should be noted that these theoretical perspectives differ in their
conceptualization of stress and place different emphasis on individual personality differences and
on situational variables that may moderate stress-burnout relations. In addition, the different
models have not been systematically compared with regard to their predictive validity of burnout.

This review argues that the most robust theoretical view of stress and burnout
relationships is that based on Hobfolls COR theory (Hobfoll & Shirom, 1993, 2000). According
to COR theory (Hobfoll, 1989, 1998), when individuals experience loss of resources, they
respond by attempting to limit the loss and maximizing the gain of resources. To achieve this,
they usually employ other resources. When circumstances at work or otherwise threaten people's
obtaining or maintaining resources, stress ensues. COR theory postulates that stress occurs under
one of three conditions: (1) when resources are threatened, (2) when resources are lost, and (3)
when individuals invest resources and do not reap the anticipated rate of return. COR theory

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(Hobfoll, 1988, 1998) further postulates that because individuals strive to protect themselves
from resource loss, loss is more salient than gain, and therefore employees are more sensitive to
workplace stresses that threaten their resources. For example, for teachers, the demand to
discipline students, and facing negative feedback from their supervisors will be more salient than
rewards that they might receive. The stress of interpersonal conflict has been shown to be
particularly salient in the burnout phenomenon (Leiter & Maslach, 1988).
A recent meta-analysis (Lee & Ashforth, 1996) examined how demand and resource
correlates and behavioral and attitudinal correlates were related to each of the three scales that
comprise the MBI. In agreement with the COR theory-based view of stress and burnout outlined
above, these authors found that both the demand and the resource correlates were more strongly
related to emotional exhaustion than to either depersonalization or personal accomplishment.
These investigators also found that consistent with COR theory of stress, emotional exhaustion
was more strongly related to the demand correlates than to the resource correlates, suggesting that
workers might have been sensitive to the possibility of resource loss. These meta-analytic results
were subsequently reconfirmed by additional studies, like Demerouti et al. (Demerouti, Bakker,
Nachreiner, & Schaufeli, 2000) who used a burnout scale that focused on energy depletion.
Applying these notions to burnout, we argue that individuals feel burned out when they
perceive a continuous net loss, which cannot be replenished, of physical, emotional, or cognitive
energy that they possess. This feeling of ongoing net loss of any combination of individuals
physical vigorousness, emotional robustness, and cognitive agility

represents an emotional

response to the experienced stresses. The net loss, in turn, cannot be compensated for by
expanding other resources, or borrowing, or gaining additional resources by investing extant
ones. Burned-out individuals may exacerbate their losses by entering an escalating spiral of

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losses (Hobfoll & Shirom, 2000). Then, they may reach an advanced stage of burnout, wherein
their symptoms of depression may become the predominant emotions, or may reach advanced
stages of burnout that manifest themselves in symptoms of psychological withdrawal like acting
with cynicism toward and dehumanizing their customers or clients. As noted by Schaufeli and
Enzmann (1998), longitudinal studies to date have not supported the notion that there is a time
lag between the stress experience and the feelings of burnout. It could be that stress and burnout
change simultaneously, and therefore the failure of the eight longitudinal studies examined by
Schaufeli and Enzmann (1998) to reproduce the effects of stress on burnout found in most crosssectional studies.
This theoretical perspective has direct implications with regard to phase or process
theories of burnout (e.g., Golembiewski & Boss, 1992; Golembiewski, Boudreau, Munzenrider,
& Lou, 1996; Leiter & Maslach, 2001). These phase or process theories of burnout have been
reviewed by Burke and Richardson (2000), who noted that such theories should include the
consequences of burnout to salient to individuals and organizations. Thus COR theory implies
that during the early stages of burnout, it will be characterized by a process of depletion of energy
resources directed at coping with the threatening demands, that is with work-related stresses.
During this stage of coping, burnout may occur concomitantly with a high level of anxiety, due
to the direct and active coping behaviors that usually entail a high level of arousal. When and if
these coping behaviors prove ineffective, the individual may give up, and engage in emotional
detachment and defensive behaviors that may lead to depressive symptoms (cf. Shirom & Ezrahi,
2001). Cherniss (1980a, b) has found that in the later stages of burnout individuals behave
defensively and hence display cynicism toward clients, withdrawal, and emotional detachment
(for empirical support, see Burke & Greenglass, 1989,1995). These attempts at coping have

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limited effectiveness and often cycle to heighten burnout and problems for both the individuals
and the organizations in which they work.

The unique core of burnout, as posited above, is

distinctive in content and nomological network from either depression or anxiety, as

demonstrated by Corrigan, Holmes, Luchins et al. (1994) and by Leiter ans Durum (1994).
Measures of depression, such as the Beck Depression Inventory (Beck, Ward, Mendelson, Mock
& Enbaugh, 1961) include items whose contents gauge passivity and relative incapacity for
purposeful action. In addition, as proposed above, later phases of burnout may be accompanied
by depressive symptomatology. The two considerations may explain the often reported high
positive correlation between burnout and measures of depression (e.g., Meier, 1984; Schaufeli &
Enzmann, 1998). It follows that burnout is conceptually distinct from depression. Depressive
symptomatology is affectively complex, and includes lack of pleasurable experience, anger, guilt,
apprehension, and physiological symptoms of distress. Moreover, cognitive views of depression
regard it as related primarily to pessimism about the self, capabilities, and the future (Fisher,
1984).
This theoretical position may be exemplified by burnout among people-oriented
professionals, such as teachers, social workers and nurses. When faced with overload and
interpersonal stress on the job on an ongoing basis, the key issue for them is the amount of
emotional energy they need to meet these job demands. When they feel emotionally exhausted,
direct or problem-focused coping, which invariably requires that they invest emotional energy, is
no longer a viable option. Presumably, they employ emotion-focused coping in an effort to
ameliorate their feelings of emotional exhaustion, and attempt to distance themselves from their
service recipients, psychologically withdraw from their job tasks, or limit their exposure to their
clients. This may explain the often found linkage between emotional exhaustion and cynicism

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(Lee & Ashforth, 1996). In a recent study of the process of burnout among general practitioners,
a study that used a five-year longitudinal design, Bakker and his colleagues (Bakker, Schaufeli,
Sixma, et al., 2000) found that repeated confrontation with demanding patients over a long period
of time depleted the GPs emotional resources, with perceptions of inequity or lack of reciprocity
mediating the process. This study (Bakke et al., 2000) also reported that emotional exhaustion
evoked a cynical attitude towards patients. However, this linkage of emotional exhaustion and
cynicism does not mean that emotional exhaustion is necessarily followed by cynical attitudes or
indirect coping styles like distancing. It does not necessarily follow from this linkage that
burnouts core meaning and ways of coping with advanced stages of it belong to the same
conceptual space (cf. Maslach, Schaufeli, & Leiter, 2001, p. 403).
Individual Traits Predisposing Employees to Burnout
In this section and those that follow, I shall refer to the empirical research that has been
published on burnout. This voluminous research was already covered in part by meta-analytic
studies (Collins, 1999; Lee & Ashforth, 1996; Schaufeli & Enzmann, 1998). The reference to
empirical studies in this review is rather selective. Most of this research has measured burnout by
the MBI. In references made to this body of studies, I shall focus on results reported for the
emotional exhaustion scale. Adverse organizational conditions have been shown to be more
significant in the etiology of burnout than personality factors (Schaufeli & Enzmann, 1998). The
lesson to burnout researchers is that it is plausible that individual traits predisposing employees to
burnout interact with organizational features that are conductive to the development of burnout.
As an example, when a major economic slump moves management to require that all employees
increase their input of available personal energy and time to ensure the organization's survival,

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those employees who possess high self-esteem are less likely to experience burnout as a result
(Cordes & Dougherty, 1993).
One of the predictions of COR theory is that individuals who lack strong resources are
more likely to experience cycles of resource losses. When not replenished, such cycles are likely
to result in chronic depletion of energy, namely progressive burnout. Cherniss (1995) posited
that the advance of burnout is contingent upon individuals level of self-efficacy, and there is
some support for this contention (Brouwers & Tomic, 2000). Lower levels of burnout would be
expected in work situations that allow employees to experience success and thus feel efficacious,
namely under job and organizational conditions that provide opportunities to experience
challenge, control, feedback of results, and support from supervisors and coworkers (cf. Schaufeli
& Buunk, 1996; Brouwers & Tomic, 2000). Thus Chang and his colleagues (Chang, Rand, &
Strunk, 2000) found, in a study of working college students, that optimism was a potent predictor
of the emotional exhaustion scale of the BMI even after the effects of stress were controlled.
Chang et al. (2000) concluded that concrete affirmation of job accomplishments, such as by merit
awards, and increasing employees optimistic expectancies may lower their risk for job burnout.
The role of personality factors in the etiology of burnout is complex and multifaceted, and
probably hardly explored (Kahill, 1988). Garden (1989; 1991) concluded that certain personality
types self-select individuals into specific occupations and that subsequently, the same individuals
interact with stressful occupational environments that are conducive to the experience of burnout.
Other possible paths of influence of personality characteristics on burnout may exist. Several
studies have reported a postive association of Type A behvaior pattern and emotional exhaustion
(Schufeli & Enzmann, 1998). Neuroticism may lead people to report higher levels of burnout
regardless of the situation (cf. Watson & Clark, 1984). Hardiness, as a personality trait, has also

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been found to buffer the effects of stress on burnout. In a study of nurses, Zellars, Perrewe and
Hochwaiter (2000) have found that among the big five personality factors, only neuroticism
predicted the MBIs emotional exhaustion scale, after controlling for the effects of
sociodemographic and stress variables.
Burnout may exacerbate certain personality traits. It appears that the complex interactions
between personality traits and burnout have yet to be described and understood. As noted, there
is some evidence that personality factors explain additional variance in job burnout even after
considering the effects of types of stress considered to be the most potent predictors of this
phenomenon.
The Consequences of Burnout: Performance in Organizations
Burnout has been linked to several negative organizational outcomes, including increased
turnover and absenteeism (e.g., Jackson, Schwab, & Schuler, 1986; Parker & Kulik, 1995), lower
organizational commitment (Maslach & Leiter, 1997), and the self-reported use of violence by
policepersons against civilians (Kop, Euwema, & Schaufeli, 1999). I shall focus here on burnout
-job performance relationships. While the available evidence is still meager, it supports the
argument that burnout is differentially related to self-assessed, supervisor-assessed and
objectively measured job performance. In general, burnout was found to be negatively related to
subjectively assessed performance but not significantly associated with objectively assessed
performance. Based on six studies, Schaufeli & Enzmann (1998) concluded that self-rated
performance correlated weakly with the MBI emotional exhaustion scale, with only about 5% of
the variance shared. In comparison, other-rated performance or objectively assessed performance,
in seven studies, was found to share only 1% of the variance with the MBI emotional exhaustion
scale, and the expected negative correlations were found in only four out of the seven studies. To

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illustrate, Parker & Kulik (1995) reported that, after controlling for negative affectivity,
performance of nurses who were higher in their feeling of emotional exhaustion was rated lower
both by the nurses themselves and independently by their supervisors.
Wright and Cropanzano (1999), using the emotional exhaustion scale (EE) of the MBI in
a longitudinal design, reported finding a correlation of -.27 between this scale and a one-item
measure of global performance as assessed by the supervisors of 52 social workers over a threeyear period. In similar vein, Wright and Bonnett (1997) found that the EE scale negatively
predicted Time 2 performance (supervisor assessed, one item tapping global performance), after
controlling for Time 1 performance, age and gender, among 44 human- service personnel. These
studies (including Parker & Kulik, 1995) failed to find relationships among performance and the
two other MBI-derived scales, depersonalization and reduced personal accomplishment, thus
lending support to the pivotal importance of emotional exhaustion in the burnout experience.
The evidence described above lends credence to the major propositions of COR theory
regarding the possible reasons for burnouts negative impact on job performance. The negative
correlation between burnout and job performance is likely to be explained by burned- out
individuals impaired coping ability and their reduced level of motivation to perform.
Organizational-level Burnout
The literature on burnout has dealt almost exclusively with the individual level of
analysis. With few exceptions (e.g., Leiter & Maslach, 1988; Leiter & Meachem, 1986;
ODriscoll & Schubert, 1988), the potentialities of investigating group or organizational burnout
have not been systematically explored. It is plausible that burnout on the individual level of
analysis has its organizational counterpart. There may be parallel processes operating at the
individual and organizational levels of analysis. The open systems approach postulates that there

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is dynamic interplay and interconnectedness among elements of any system, its subsystems, and
within the more inclusive system. Focusing on organizational burnout may entail a much higher
system complexity than the extant focus on individual burnout (cf. Staw, Sandelands, & Dutton,
1981).
A process of depletion of organizational resources may be self-imposed by those at the
helm of the organization, like setting unrealistic production targets that overload and overuse the
employees available energetic resources, eventually also exacerbating their level of' burnout.
This process may be externally imposed by stakeholders' excessive demands for product or
service quality that continuously deplete the organization's energetic resources. Kramer (1990,
1991) has summarized the literature on the effects of resource scarcity on group and intergroup
conflict and cooperation. Organizational Behavior has imported the resource-based model of the
firm from Economics as a major theoretical framework. Within this resource-based view of
organizations, issues like resource mobility and heterogeneity have been applied to explain firms'
competitive advantage (Barney, 1991).
There is indirect evidence from several studies that there exist a phenomenon of
concentration of burned- out employees in certain work groups. Roundtree (1984) studied task
groups in organizations and found out that almost 90% of those high on burnout were members of
work groups having at least 50% of all their members suffering from advanced burnout. Bakker
and Schaufeli (2000) found evidence for burnout contagion processes among teachers. Still, the
evidence is largely indirect and does not clarify if the concentration of burned- out employees in
certain work groups is due to common exposure to stress, contagion processes that operate in
these work groups, or other possible alternative explanations. Organizational burnout may lead to

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organizational decline and death. Organizational decline and downsizing, (Mone, McKinley, &
Barker, 1998) may be likened to the chronic fatigue stage of burnout.
Approaches to Reducing Burnout
In this section, I review studies that evaluated interventions designed to reduce burnout. It
has been argued that workplace-based interventions aimed at reducing stress and modifying some
of the maladaptive responses to stress often have little or no effect (Briner & Reynolds, 1999). Is
this conclusion relevant to interventions designed to ameliorate burnout? Most of the burnout
interventions reported in the literature are individual-oriented and provide treatment, not
prevention, much like other stress interventions (Nelson, Quick, & Simmons, 2001). There are
hardly any reports on interventions that were based on a systematic audit of the structural sources
of workplace burnout with the objectives of alleviating or eliminating the stresses leading to
burnout.
An intervention frequently used by organizations attempting to ameliorate burnout
amongst their employees is peer support groups. The theoretical perspective offered in this
chapter may explain the focus of many interventions on enriching and strengthening the social
support available to or utilized by burned-out employees. According to the predictions of COR
theory, the depletion of one's energetic resources and impoverished social support are closely
related (Hobfoll, 1989, 1998). Those lacking a strong resource pool, including those with
impoverished social support, are more likely to become burned-out, or to go through cycles of
resource loss when they cope with work-related stress. Additionally, people with depleted
energetic resources, who complain of physical fatigue, emotional exhaustion, and cognitive
weariness, may appear to their significant others at work as less attractive and therefore less
likely to have access to social support. There is considerable support for these arguments. In a

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21

review of the area of social support and stress, Curtona and Russell (1990) integrated four studies
that had investigated the effects of social support on burnout among public school teachers,
hospital nurses, therapists, and critical care nurses, respectively. In all four studies, negative
associations between social support and burnout were found. For reasons explained above, these
negative relationships may be reciprocal.
The peer social support intervention is particularly popular in educational institutions
(e.g., Travers & Cooper, 1996; Cooley & Yavanoff, 1996; Vandenberghe & Huberman, 1999).
Such peer-based support groups provide their members with informational and emotional
support, and in some cases instrumental support too (Burke & Richardson, 2000). Since social
support is a major potential route to resources that are beyond those that individuals possess
directly, it is a critical resource in many employment-related stressful situations (Hobfoll &
Shirom, 2000) and may help them to replenish their depleted energetic resources. However, how
social support is actually used is dependent on several factors, including ones sense of mastery
and environmental control.
In a longitudinal research of burnout among teachers, Brouwers and Tomic (2000) found
that emotional exhaustion had a negative effect on self-efficacy beliefs and that this effect
occurred simultaneously rather than over time. They (Brouwers & Tomic, 2000) reasoned that
interventions that incorporate enactive mastery experiences, the most important source of selfefficacy beliefs, were likely to have an ameliorative effect on teachers emotional exhaustion. An
example would be having teachers learn and experiment with skills to cope with disruptive
students behaviors. In the same vein, the environmental sense of control is an important stress
management resource (cf. Fisher, 1984). Those with a high sense of control tend to use their
resources judiciously, relying on themselves when this is deemed most appropriate and using

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available social support when this is the more effective coping route (Hobfoll & Shirom, 2000).
Therefore, interventions that combine both social support and bolstering of control may be more
efficacious in reducing burnout in organizations. For example, a multifaceted intervention that
combined peer social support and bolstering of professional self-efficacy was found to reduce
burnout (measured by the S-MBM) relative to a control group of non-participants (Rabin, Saffer,
Weisberg et al., 2000). Yet another example is the study of Freedy and Hobfoll (1994), who
enhanced nurses coping skills by teaching them how to use their social support and individual
mastery resources and found a significant reduction in emotional exhaustion in the experimental
group relative to the non-treated control group.
Senior management has a role to play in instituting preventive measures, including steps
to ameliorate chronic work-related stress, particularly overload; training programs designed to
promote effective stress management techniques and on-site recreational facilities.
Organizational interventions to reduce burnout have great potential, but are complex to
implement and costly in terms of resources required. The changing nature of employment
relationships, including the transient and dynamic nature of employee-employer psychological
contract, entails putting more emphasis on individual-oriented approaches to combat burnout.
The role of individual coping resources, including self-efficacy, hardiness, and social support
from friends and family, may become more important in future interventions.
Directions for Future Research
An important area for future research is the discriminating validity of burnout, according
to either of its different operational definitions, and other types of emotional distress, particularly
anxiety and depression. I have argued that burnout, anxiety and depression are conceptually
distinct emotional reactions to stress. Studies that support this contention were cited above (e.g.,

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23

Schaufeli & Dierendonck, 1993). Still, the overlap found in several studies (Schaufeli &
Enzmann, 1998; Cherniss, 1995) between depression and the emotional exhaustion scale of the
MBI, the most robust and reliable out of the three scales that comprise the MBI, is a cause for
concern. The propositions that early stages of individuals burnout are more likely to be
accompanied by heightened anxiety while more progressive stages of burnout may be linked to
depressive symptomatology need to be tested in longitudinal research.
The plausibility of the proposition that burnout, as conceptualized here in terms of its core
meaning, will overlap to some extent with the disease state of Chronic Fatigue Syndrome (CFS)
or with its immediate precursor, chronic fatigue, has yet to be tested. In future investigations,
individuals who score highest on burnout measures should be followed up for possible
development of CFS.
Yet another important area of research concerns burnout as a possible precursor of
cardiovascular disease. Early in the 1960's and 1970's, prospective studies found that being tired
on awakening, or being exhausted at the end of the day, were possible antecedents of
cardiovascular heart disease (Appels & Mulder, 1988, 1989). Appels and Mulder (1988, 1989)
found out that those initially high on their measure of vital exhaustion (a combination of burnout,
anxiety, and depression) were significantly more at risk to develop myocardial infarction within
four years, after controlling for known risk factors such as blood pressure, smoking, cholesterol
and age (cf. Appels & Schouten, 1991). In cross-sectional studies that tested the associations
among cardiovascular risk factors and burnout, Melamed, Kushnir and Shirom (1992) and
Shirom and Melamed (1991) found evidence linking the two entities. In a semi-longitudinal
study, Shirom and his colleagues (Shirom, Westman, Shamai, & Carel, 1997) were able to show
that burnout predicts elevated levels of cholesterol and triglycerides among respectively male and

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24

female blue-collar employees. Longitudinal studies of fairly large and occupationally

representative samples should be conducted to cross-validate these findings.
Conclusions
Given the data provided on the prevalence of burnout in advanced market economies,
improving our understanding of the complex relationships between stress and burnout is critical
for informing prevention, intervention, and public policy efforts. Advances in our knowledge are
unlikely to results from research employing fuzzy concepts and relying upon instruments whose
construct validity is in doubt. For this reason, in this review I have selectively focused on
theoretical and conceptual issues in burnout research.
Burnout research still has to uncover the specific contexts in which stress exerts it effects
on burnout. A recent meta-analysis of the literature (Collins, 1999) suggested that when the
effects of different types of stress on burnout are compared across studies, larger effect sizes are
obtained with job-specific relative to generic chronic stress measures like role conflict and
ambiguity. The effects of stress on burnout were shown in this review and its predecessors to
vary across situational factors, available coping resources such as social support and control, and
enduring personal factors such as neuroticism and hardiness. It follows that future research
should look for moderators and mediators of stress- burnout relationships.
Burnout is likely to represent a pressing social problem in the years to come.
Competitive pressures in manufacturing industry that originate in the global market, the
continuing process of consumer empowerment in service industries, the rise and decline of the
high-tech industry are among the factors likely to affect employees levels of burnout in different
industries. In addition, employees in many advanced market economies experience heightened
job insecurity, demands for excessive work hours, the need for continuous retraining in the wake

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25

of the accelerating pace of change in informational technologies, and the blurring of the line
separating work and home life. In many European countries, employers are enjoined by
governmental regulations on occupational health to implement preventive interventions that
concern job stress and burnout. This review is an attempt to steer future research on burnout
along the line suggested above thus to make future preventive interventions more efficacious.

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26

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